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Cortisone might get athletes back in game quicker, but does it send wrong message?

Dr. Geier

Jul 30 2013 9:41 pm

A study presented at the American Orthopaedic Society for Sports Medicine’s Annual Meeting held in Chicago last week offers exciting news for team doctors and athletes regarding a difficult injury. It also might perpetuate the notion that team doctors seek only to get players back on the field at all costs.

Syndesmosis injuries of the ankle, better known as high ankle sprains, can be some of the most frustrating injuries that football, hockey and soccer players suffer. In addition to tearing some of the ligaments on the side of the ankle, athletes also disrupt the ligaments between the tibia (shin bone) and fibula (bone on the outer leg). Fortunately, high ankle sprains rarely require surgery, but they can sideline players for 4 to 6 weeks.

Dr. Alfred A. Mansour and others presented data that cortisone shots can help return NFL players to action faster after these injuries. They collected data from two NFL teams over eight seasons. They found that players who received corticosteroid injections into the damaged ankle tissue within 72 hours of injury returned to play an average of 10 days faster (15 vs. 25 days missed) than those who received the traditional rehabilitation program.

“For high-level athletes such as NFL players, returning to play 10 days sooner can have a significant impact personally and for the team,” Dr. Mansour noted.

It certainly impacts the surgeons who work with elite athletes. After all, we get them back to doing what they love. These cortisone shots might help us do so 40 percent faster after high ankle sprains.

It definitely impacts professional sports teams as well. Having star players on the field improves chances of winning titles. (Remember New England’s Rob Gronkowski struggling with a high ankle sprain in the Super Bowl?)

Plus, with NFL players’ salaries averaging $1.9 million, getting a player back a week earlier “saves” the team more than $100,000.

And players have shown over and over that they often ignore symptoms and try to play no matter what. Maybe they fear losing their roster spots or starting positions. Maybe they don’t want to let teammates down. Regardless, if a cortisone shot get them on the field t10 days faster, most of them would probably take it.

It seems that everyone stands to gain if these simple procedures speed return to sports. But does it also provide ammunition to fans and critics who believe team doctors shoot up players and rush them back on the field?

To be fair, cortisone shots for high ankle sprains probably aren’t that big of a concern. This study only looked at the number of days missed and not long-term effects on the ankles or years played after the injuries, though.

Cortisone is probably effective only as a means of decreasing pain and swelling. It does little to treat the underlying injury. For many athletic injuries — tennis elbow, patellar tendinitis, Achilles tendinitis and others — cortisone is actually falling out of favor. Its anti-inflammatory properties likely stop or slow down the very inflammatory process these tissues need to heal.

Deserved or not, there seems to be an increasingly common perception that team physicians don’t always have players’ long-term health in mind. Stories of long lines of football players bent over receiving Toradol injections before games have drawn much attention. Athletes remaining on the field despite “concussion-like symptoms” or playing on obviously damaged knees when they are “hurting” but “not injured” don’t help.

Players share this concern, too. A recent NFLPA survey asked players on all 32 teams to rate the level of trust they have in their team doctors on a scale of 1 to 5, with five being the worst. 78 percent rated their trust as a five.

Many players believe the team doctors essentially work for the teams. As such, the physicians aim to do solely what is best for the organization. With the immense exposure of professional sports in our society, it is no surprise that hospitals pay large sums of money to be “official healthcare providers” of teams. According to Slate Magazine, 23 of 32 NFL teams have these types of financial relationships with groups that provide medical care to their players.

I will say that the vast majority of sports medicine orthopaedic surgeons consistently work to treat athletes in ways that are best for their overall health and well-being. We want the athletes playing for many years and healthy after their careers end. But there are definitely pressures from all directions pushing us to get players back as fast as possible. Even if it isn’t deserved, there is growing perception among players and fans that we might be going too far.

Dr. David Geier is an orthopaedic surgeon and sports medicine specialist in Charleston. For more information about football injuries and other sports medicine topics, go to Dr. Geier’s blog at drdavidgeier.com.

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